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Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population‐based study
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Background: Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild cognitive impairment (MCI), newly discovered dementia, and prevalent dementia. Methods: Subjects were a subset of the Mayo Clinic Study of Aging stratified‐random sampling of Olmsted County, MN, residents aged 70 to 89 years. A neurologist reviewed provider‐linked medical records to identify prevalent dementia (review date = index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly discovered dementia (assessment date = index). Costs for medical services/procedures 1‐year pre‐index (excluding indirect and long‐term care costs) were estimated using line‐item provider‐linked administrative data. We estimated contributions of care‐delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between‐category cost differences. Results: Annual mean medical costs for CN, MCI, newly discovered dementia, and prevalent dementia were $6042, $6784, $9431, $11,678, respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age‐, sex‐, education‐adjusted differences reached significance for CN versus newly discovered and prevalent dementia and for MCI versus prevalent dementia. After considering all comorbid diagnoses, between‐category differences were reduced (e.g., prevalent dementia minus MCI (from $4842 to $3575); newly discovered dementia minus CN (from $3578 to $711)). Following the exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between‐category differences tended to revert to greater differences. Conclusions: Cost estimates did not differ significantly between CN and MCI. Substantial differences between MCI and prevalent dementia reflected high inpatient costs for dementia and appear partly related to co‐occurring mental disorders. Such comparisons can help inform models aimed at identifying where, when, and for which individuals proposed interventions might be cost‐effective.
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“In a population-based study of adults age 70 to 89, annual health care costs were significantly higher for individuals with dementia than for those with either mild cognitive impairment (MCI) or without cognitive impairment.732”
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“In a population‐based study of adults age 70 to 89, annual health care costs were significantly higher for individuals with dementia than for those with either mild cognitive impairment (MCI) or without cognitive impairment. 878”
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“Health care costs increase with the presence of dementia.”
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“Annual health care costs for individuals with MCI were not significantly different, however, from costs for individuals without cognitive impairment.”
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Metadata
- Authors
- Leibson, C. L., Long, K. H., Ransom, J. E., Roberts, R. O., Hass, S. L., Duhig, A. M., Smith, C. Y., Emerson, J. A., Pankratz, V. S., & Petersen, R. C.
- Affiliations
- Mayo Clinic (US)
- K Long Health Economics Consulting LLC St. Paul MN USA
- AbbVie (United States) (US)
- Corresponding author
- Leibson, Cynthia L.
- ORCID
- Venue
- Alzheimer's & Dementia
- Publisher
- Wiley
- Published
- 2015-04-06
- Volume
- 11
- Issue
- 8
- Pages
- 917-932
- ISSN
- 1552-5260 (ISSN-L)
- 1552-5279
- PMC
- PMC4543557
- OpenAlex
- W2114983566
- Cited by
- 110
- References
- 81
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 13 · 2023: 10 · 2022: 15 · 2021: 19 · 2020: 7 · 2019: 5 · 2018: 8 · 2017: 6 · 2016: 4
- FWCI
- 4.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Alzheimer s & Dementia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging
- National Institutes of Health (R01 AG034676)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- direct medical costs, mild cognitive impairment
- MeSH terms
- Aged, Aged, 80 and over, Aging, Cognition Disorders, Cross-Sectional Studies, Dementia, Female, Humans, Male, Neuropsychological Tests, Patient Acceptance of Health Care, Databases, Factual, Health Care Costs, Disease Progression, Community Health Planning
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